Practice question Pathology of breast III

Practice question

Pathology of breast III

© Jun Wang, MD, PhD

 

1. Use this image for the next two questions. A 42-year-old woman presents to the clinic with a left breast mass for 1 month. She does not have history of trauma. She has had type 2 diabetes for 5 years and has been treated with metformin. Her family history is significant for multiple cancers including endometrial carcinoma and benign ovarian tumors. Physical examination reveals a 2.5 cm mobile firm mass at the outer upper  quadrant of her left breast. No other abnormalities are noted. An image of her biopsy is shown. What is the diagnosis?

 (No machine-readable author provided. KGH assumed (based on copyright claims)., CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons)

A. Diabetic mastopathy
B. Fibroadenoma
 C. Fibrocystic changes
 D. Invasive ductal carcinoma
 E. Invasive lobular carcinoma
 F. Usual ductal hyperplasia

2. A 42-year-old woman presents to the clinic with a left breast mass for 1 month. She does not have history of trauma. She has had type 2 diabetes for 5 years and has been treated with metformin. Her family history is significant for multiple cancers including endometrial carcinoma and benign ovarian tumors. Physical examination reveals a 2.5 cm mobile firm mass at the outer upper  quadrant of her left breast. No other abnormalities are noted. An image of her biopsy is shown. What is the diagnosis?

What will be the most likely immunohistochemistry study finding?


(No machine-readable author provided. KGH assumed (based on copyright claims)., CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons)


A. Her2 overexpression
 B. Loss of E-cadherin
 C. p53 reactivity in glandular cells
 D. p63 positive cells at base of ducts
 E. Polyclonal B cells

 

3. Use this image for the next two questions. A 43-year-old woman presents with microcalcifications identified by mammogram screening. Her past medical history is unremarkable. Physical examination reveals no abnormalities. An image of her biopsy is shown. What is the diagnosis?


 (Image credit: Manuel Medina from Osuna, España, Public domain, via Wikimedia Commons)


A. Atypical ductal hyperplasia
 B. Ductal carcinoma in situ
 C. Fibrocystic changes
 D. Invasive ductal carcinoma
 E. Mucinous carcinoma

4. A 43-year-old woman presents with microcalcifications identified by mammogram screening. Her past medical history is unremarkable. Physical examination reveals no abnormalities. An image of her biopsy is shown. What is most likely associated with these changes?


(Image credit: Manuel Medina from Osuna, España, Public domain, via Wikimedia Commons)


A. BRCA1 mutation
 B. Estrogen effect
 C. Her2 amplification
 D. Loss of E-cadherin
 E. Recent trauma

 

5. Use this image for the next question. A 51-year-old woman presents to the clinic with a slowly growing right breast mass for 2 months. She denies other symptoms. She has a family history of breast and ovarian cancers in the maternal side. Physical examination reveals a 2.5 cm mobile mass at the outer upper quadrant. An image of her biopsy is shown. What is the diagnosis?

(Image: Nephron, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
 
A. Fibroadenoma
 B. Ductal carcinoma in situ
 C. Invasive ductal carcinoma
 D. Papilloma
 E. Phyllodes tumor

 

6. Use this image for the next two questions. A 44-year-old woman presents to the clinic for a mammographic finding of left breast retroareolar growth. She has a history of diabetes. Her family history reveals multiple members with colon and lung cancers. Physical examination reveals no significant abnormality. An image of her biopsy is shown. No significant cytological atypia is seen. CD10 stain reveals positive reactivity at the base of epithelial lining. What is the diagnosis?


(Image: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
 
A. Diabetic mastopathy
B. Ductal carcinoma in situ
 C. Intraductal papilloma
 D. Invasive ductal carcinoma
 E. Lobular carcinoma in situ

7. A 44-year-old woman presents to the clinic for a mammographic finding of left breast retroareolar growth. She has a history of diabetes. Her family history reveals multiple members with colon and lung cancers. Physical examination no significant abnormality. An image of her biopsy is shown. No significant cytological atypia is seen. CD10 stain reveals positive reactivity at the base of epithelial lining. What is the most common clinical presentation of her condition?


(Image: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)


A. Bloody nipple discharge
 B. Eczematous nipple changes
 C. Mammographic finding of microcalcification
 D. Multiple nodular growth
 E. Palpable mass

 

8. Use this image for the next question. A 44-year-old woman presents to the clinic for a mammographic finding of left breast architecture changes. Her past medical history is unremarkable. Physical examination revelas no significant abnormality. Image study reveals a 0.7 cm poorly demarcated mass. An image of her biopsy is shown. No significant cytological atypia is seen. CD10 stain reveals intake myoepithelial layer. What is the diagnosis?


(Image: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest:  NoneMikael Häggström, M.D. Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia Commons)


A. Ductal carcinoma in situ
 B. Intraductal papilloma
 C. Invasive ductal carcinoma
 D. Radial scar
 E. Sclerosing adenosis

9. Use this image for the next question. A 44-year-old woman presents to the clinic for a mammographic finding of left breast architecture changes. Her past medical history is unremarkable. Physical examination revelas no significant abnormality. An image of her biopsy is shown. No significant cytological atypia is seen. CD10 stain reveals intake myoepithelial layer. What is the diagnosis?

 

(Image: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest:  NoneMikael Häggström, M.D. Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia Commons)
  
A. Ductal carcinoma in situ
 B. Intraductal papilloma
 C. Invasive ductal carcinoma
 D. Radial scar
 E. Sclerosing adenosis

 

10. Use this image for the next two questions. A 44-year-old woman presents with microcalcifications and altered architecture identified by mammogram screening. Her past medical history is unremarkable. Physical examination reveals no abnormalities. An image of her biopsy is shown. CD10 stain reveals intake myoepithelial layer. What immunohistochemistry marker should be examined next?



(Image: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
  
A. E-cadherin
 B. Estrogen receptor
 C. Her2
 D. p53
E. Progesterone receptor

11. A 44-year-old woman presents with microcalcifications and altered architecture identified by mammogram screening. Her past medical history is unremarkable. Physical examination reveals no abnormalities. An image of her biopsy is shown. CD10 stain reveals intake myoepithelial layer.  

These cells are positive for E-cadherin. What is the diagnosis?


(Image: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
 
 A. Ductal carcinoma in situ
 B. Intraductal papilloma
 C. Invasive ductal carcinoma
 D. Radial scar
 E. Sclerosing adenosis

 


12. Use this image for the next question. A 44-year-old woman presents to the clinic for a mammographic finding of left breast architecture changes. Her past medical history is unremarkable. Physical examination reveals no significant abnormality. An image of her biopsy is shown. No significant cytological atypia is seen. CD10 stain reveals intake myoepithelial layer. What is the diagnosis?
(Image: No machine-readable author provided. KGH assumed (based on copyright claims)., CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons)
  
A. Ductal carcinoma in situ
 B. Intraductal papilloma
 C. Invasive ductal carcinoma
 D. Radial scar
 E. Sclerosing adenosis



13. Use this image for the next two questions. A 44-year-old woman presents with microcalcifications and altered architecture identified by mammogram screening. Her past medical history is unremarkable. Physical examination reveals no abnormalities. An image of her biopsy is shown. CD10 stain reveals intake myoepithelial layer. What immunohistochemistry marker should be examined next?
(Image: Difu Wu., CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
  
A. E-cadherin
 B. Estrogen receptor
 C. Her2
 D. p53
E. Progesterone receptor

14. A 44-year-old woman presents with microcalcifications and altered architecture identified by mammogram screening. Her past medical history is unremarkable. Physical examination reveals no abnormalities. An image of her biopsy is shown. CD10 stain reveals intake myoepithelial layer.

These cells are negative for E-cadherin. What immunohistochemistry marker should be examined next?

(Image: Difu Wu., CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons)
  
A. Ductal carcinoma in situ
 B. Invasive ductal carcinoma
 C. Invasive lobular carcinoma
 D. Lobular carcinoma in situ
 E. Usual ductal hyperplasia

 


15. Use this image for the next two questions. A 42-year-old woman presents to the clinic with a slowly growing mass of her left breast for three months. Her past medical history and family history is unremarkable. Physical examination reveals a 2.5 cm firm mass with irregular borders in the outer upper  quadrant. An image of her biopsy is shown. These cells are positive for estrogen receptor and progesterone receptor. What additional immunohistochemistry study needs to be performed?

(Image: Calicut Medical College, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
 A. CK5/6
 B. E-cadherin
 C. Her2
 D. p53

16. A 42-year-old woman presents to the clinic with a slowly growing mass of her left breast for three months. Her past medical history and family history is unremarkable. Physical examination reveals a 2.5 cm firm mass with irregular borders in the outer upper  quadrant. An image of her biopsy is shown. These cells are positive for estrogen receptor and progesterone receptor. What is the diagnosis?

(Image: Calicut Medical College, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
  
A. Ductal carcinoma in situ
 B. Invasive ductal carcinoma
 C. Invasive lobular carcinoma
 D. Lobular carcinoma in situ
 E. Usual ductal hyperplasia

 


17. Use this image for the next three questions. A 51-year-old woman presents with left breast mass for a month. She has a history of lung adenocarcinoma 5 years ago that was treated with surgery and chemotherapy. She has 30 pack year history of cigarette smoking but has quit since she was diagnosed with lung cancer. Physical examination reveals a firm fixed mass at the lower inner quadrant. An image of her biopsy is shown. Per immunohistochemistry studies, these cells are positive for E-cadherin and negative for TTF-1. What is the most likely additional findings for this lesion?
(Image: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest:  NoneMikael Häggström, M.D. Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia Commons)
  
A. ER negative, Her2 negative
 B. ER negative, Her2 positive
 C. ER positive, Her2 negative
 D. ER positive, Her2 positive



18. A 51-year-old woman presents with left breast mass for a month. She has a history of lung adenocarcinoma 5 years ago that was treated with surgery and chemotherapy. She has 30 pack year history of cigarette smoking but has quit since she was diagnosed with lung cancer. Physical examination reveals a firm fixed mass at the lower inner quadrant. An image of her biopsy is shown. Per immunohistochemistry studies, these cells are positive for E-cadherin and negative for TTF-1.
 
 Additional immunohistochemistry studies reveals these epithelial cells are negative for estrogen receptor, progesterone receptor and Her2, in a background of mixed CD3+ and CD20+ lymphocytes. What is the diagnosis?

(Image: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest:  NoneMikael Häggström, M.D. Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia Commons)
 A. Diffuse large B cell lymphoma
 B. Ductal carcinoma in situ
 C. Invasive ductal carcinoma
 D. Invasive lobular carcinoma
 E. Medullary carcinoma
 F. Metastatic lung adenocarcinoma

19. A 51-year-old woman presents with left breast mass for a month. She has a history of lung adenocarcinoma 5 years ago that was treated with surgery and chemotherapy. She has 30 pack year history of cigarette smoking but has quit since she was diagnosed with lung cancer. Physical examination reveals a firm fixed mass at the lower inner quadrant. An image of her biopsy is shown. Per immunohistochemistry studies, these cells are positive for E-cadherin and negative for TTF-1.

Additional immunohistochemistry studies reveals these epithelial cells are negative for estrogen receptor, progesterone receptor and Her2, in a background of mixed CD3+ and CD20+ lymphocytes. What is genetic abnormality is most likely associated with this lesion?

(Image: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest:  NoneMikael Häggström, M.D. Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia Commons)
 A. Bcl2
 B. BRCA1
 C. CDH1
 D. CHEK2
 E. Cyclin D1
 
20. Use this image for the next two questions. A 55-year-old woman presents to the clinic with a vague non-tender growing in her left breast for a few months. She does not have nipple discharge. She was diagnosed with chronic lymphocytic leukemia a year ago. Her family history is unremarkable. Physical examination reveals a subtle firmness at the inner lower quadrant. Sonographic examination reveals an ill-defined hypoechoic lesion. An image of her biopsy is shown. What is the diagnosis?

(Image: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
  
A. Ductal carcinoma in situ
 B. Invasive ductal carcinoma
 C. Invasive lobular carcinoma
 D. Mucinous carcinoma
 E. Small lymphocytic lymphoma

21. A 55-year-old woman presents to the clinic with a vague non-tender growing in her left breast for a few months. She does not have nipple discharge. She was diagnosed with chronic lymphocytic leukemia a year ago. Her family history is unremarkable. Physical examination reveals a subtle firmness at the inner lower quadrant. Sonographic examination reveals an ill-defined hypoechoic lesion. An image of her biopsy is shown. Abnormality of what gene is likely to be associated with these findings?

(Image: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
  
A. Bcl2
 B. BRCA1
 C. CDH1
 D. Her2
 E. MIR15A/MIR16A



22. Use this image for the next two questions. A 55-year-old woman presents to the clinic with a two-month history of itching, burning, and redness of the right nipple. She has occasional serous discharge during this period. Her past medical history is unremarkable. Physical examination reveals erythematous changes of the right nipple. A mammogram reveals scattered microcalcifications in the retroareolar area. An image of the nipple biopsy is shown. These cells are positive for cytokeratin and negative for S-100. What is the diagnosis?
 (Sarahkayb, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
  
A. Allergic contact dermatitis
 B. Invasive ductal carcinoma
 C. Invasive lobular carcinoma
 D. Junctional nevus
 E. Melanoma
 F. Paget disease


23. A 55-year-old woman presents to the clinic with a two-month history of itching, burning, and redness of the right nipple. She has occasional serous discharge during this period. Her past medical history is unremarkable. Physical examination reveals erythematous changes of the right nipple. A mammogram reveals scattered microcalcifications in the retroareolar area. An image of the nipple biopsy is shown. These cells are positive for cytokeratin and negative for S-100. What is most likely the underlying disease of these changes?

(Sarahkayb, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
 A. Ductal carcinoma
 B. Ductal ectasia
 C. Fibrocystic changes
 D. Lobular carcinoma
 E. Usual ductal hyperplasia

 

Answers

Back to pathology of breast

Back to contents

 

Comments

Post a Comment

Popular posts from this blog

Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas...
Read more

Anemia

Anemia Updated: 07/13/2024 © Jun Wang, MD, PhD   General features Decrease in red cell mass Hemoglobin: Levels of hemoglobin in a specific volume of whole blood Hematocrit: Fraction of whole blood composed of red blood cells Red cell count: Quantity of red cell in a specific volume of whole blood Three major groups based on RBC sizes Microcytic Normocytic Macrocytic Three major causes Blood loss: acute or chronic Increased red cell destruction: hemolysis Reduced production: marrow failure due to genetic abnormality or nutritional deficiency Etiology Genetic abnormality Hemoglobinopathies RBC cytoskeletal abomorlities Enzyme abnormalities Fanconi anemia Nutritional deficiencies: iron, VB12, folate, general malnutrition Physical etiologies: trauma, burns, frostbite, prosthetic valves, etc Chronic diseases: chronic infections, neoplasia, autoimmune disorders, kidney or liver diseases, etc Infectious diseases: hepatitis, sepsis , malaria, e...
Read more

Female genital tract

Pathology of female genital tract   Updated: 01/23/2024 © Jun Wang, MD, PhD Key anatomic features Opened channel, pathological basis for pelvic inflammatory disease Cervix: exocervix, endocervix, transformation zone Uterus: fundus, body Fallopian tube: intramural, isthmus, ampulla, infundibulum, fimbriae Placenta: umbilical cord, fetal membrane, placenta Key histologic features Stratified squamous epithelium from vulva to exocervix Simple columnar epithelium from endocervix to fimbriae Uterine corpus Endometrium: Glands, stroma Myometrium Perimetrium: Mesothelium/peritoneum Ovaries: three components Epithelium (mesothelium) Stroma Germ cells (follicles) Placenta: Cytotrophoblast, syncytiotrophoblast, intermediate trophoblast Infectious/inflammatory diseases Diseases of vagina and vulva Molluscum contagiosum Lichen sclerosus Paget disease Sarcoma botryoides Squamous cell carcinoma Diseases of cervix Cervical intraepithelial ne...
Read more